Innovations in Surgical Environments_Workshop presentation_part 1 by Clemson Center for Health Facilities Design & Testing

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WELCOME

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INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

Forum Room Breakout 1

Seminar 3 Breakout space Seminar 2 Breakout 4 Breakout space Breakout 2

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#RIPCHDOR

n g i #CLEMSONARCHPLUSHEALTH s e SHARE YOUR IMAGES TO: y D t i s s r e i t e i l v SHARE YOUR IMAGES TO: i i c n a U F n h o t l ARE YOUR IMAGES TO: s a m e e H l #CLEMSONARCHPLUSHEALTH r C o f #RIPCHDOR r e t #CLEMSONARCHPLUSHEALTH n e C #RIPCHDOR FACULTY OFC 222

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USING THE HASHTAGS:

Mock-up

Breakfast, Lunch & Refreshments

BreakoutRoom 5 Conference Breakout space

USING THE HASHTAGS:

Restrooms

Stairs & Elevators

USING THE HASHTAGS:

LEMSONARCHPLUSHEALTH #RIPCHDOR

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

WORKSHOP SPONSORS

Thank you!!!

Platinumn

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n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f Gold

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Silver

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Silver INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

TEAM

Thank you!!!

ANJALI JOSEPH

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HERMINIA MACHRY

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RUTALI JOSHI

DAVID ALLISON

DEBORAH WINGLER

ROXANA JAFARI

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JAMES MCCRACKEN

HEATHER HINTON

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SAHAR MIHANDOUST

LISA HOSKINS

UNIZA RAHMAN

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

Thank you!!!

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WORKSHOP AGENDA DAY 1 SEPTEMBER 12, 2019 08:30 – 09:00 09:00 – 10:00 10:00 – 11:00

Welcome & introductions Keynote: Innovations in surgical environments Case study exemplars

11:00 – 11:15

Morning break

11:15 – 12:00 12:00 – 12:30

Designing preoperative & postoperative workspaces Designing waiting areas

12:30 – 01:30

Lunch

01:30 – 01:45 01:45 – 02:30 02:30 – 03:15

RIPCHD.OR project introduction RIPCHD.OR research findings Safe OR prototype & “Safe OR Design Tool” preview

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03:30 – 03:45 03:45 – 04:00 04:00 – 05:15 05:15 – 05:45 05:45 – 07:00 07:00 – 09:00

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Andrew Ibrahim Lynn Martin, Mark Gesinger; Cara Tubbs, Michael Folonis

Afternoon break

Design implementation Future state OR Panel discussion Recognition and closing remarks Evening Networking Reception Dinner (individual choice)

Becky Smith

William Berry, Alex Langerman, Bryan Langlands, Lynn Martin, David Ruthven

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

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n g i s e y D t i s s CENTER FOR HEALTH FACILITIES DESIGN r e i t e i l v i i c n a U F n h AND eTESTING OVERVIEW o t l a ms e H l r C o f r e t n e C INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

CENTER FOR HEALTH FACILITIES DESIGN AND TESTING

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n g i s e ty CLEMSON UNIVERSITY THED MEDICAL UNIVERSITY OF i s SOUTH CAROLINA s r e i t e i l v i i c Un a F n h o t l s a m e e H l r C o f

GRANT FROM THE SMART STATE CENTER OF ECONOMIC EXCELLANCE

SCHOOL OF ARCHITECTURE

COLLEGE OF MEDICINE

DEPARTMENT OF PUBLIC HEALTH

COLLEGE OF NURSING

SRHS Endowed Chair in Architecture + Health

SRHS Endowed Chair in Clinical Practice and Human Factors

ANJALI JOSEPH

KEN CATCHPOLE

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VISION

INTERDISCIPLINARY DESIGN & RESEARCH ES N I L

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OV IDE

N M E SY ENT NT IT S E TEM IES PR S

R HU CA R I A M E EN AN A HEA G LTH IN FA PR EE

PRO FE IND SSI O HE A LTH UST N

ST R IN Y I D TR NDU UST ST RY Y RY

CA CA RE T CO RE PA M P M

D IN N IT ME G P IN UI EQ UILD HC US B HC ND

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EN PA D

NT ER IE N ER RT VID Y RO NIT U

E IG CTUR L S A DE ITE L CH S R OR S T C ING SION R ES F O

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TH L EA

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

CENTER FOR HEALTH FACILITIES DESIGN + TESTING (CHFDT) GOALS

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e T Researchd n a n g i s e Develop new, rigorous and y D t i s replicable research models s r e i anditmethods e l v i i c Un a F Create a National Design research n h‘observatory’ o t or ‘testing laboratory’ l s a m e e H l Develop and test new concepts r C foBuild and take new risks

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RESEARCH FOCUS

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e T SETTINGS BUILT REPEATEDLY IN HEALTHCARE FACILITIES AND SYSTEMS nd a n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f PATIENT SAFETY PATIENT AND STAFF EXPERIENCE POPULATION HEALTH r e t n e C SETTINGS WHERE SIGNIFICANT PATIENT CARE AND TREATMENT ARE DELIVERED

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

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SIGNIFICANCE

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VISITS TO SURGICAL CENTERS Between 1996 and 2006 There has been a 300% increase in

Between 2014 and 2021, there is an expected 8-16% increase anually for outpatient hospital surgical procedures alone.

(Cullen, 2009)

The type of surgeries has increased from in

1981

2016

(Advancing Surgical Care Association, 2016)

Number of surgical and non-surgical procedures

n g i s e y D t i s s r 53.3 e i t e i million l v i i c n a U RANGE OF SURGERIES F n h o t l s 31.5 a m million 200 3,600 He e l r C o f r e t n e C the visits to the freestanding ambulatory services while there has been no increase in the rate of visits to hospital based surgical centers.

(Munnich & Parante, 2014)

1996

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SIGNIFICANCE

OR is a highly complex riskprone area

World Alliance for Patient Safety, 2008

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5 out of every 1000 ambulatory surgical procedures results in a post surgical acute care visit for surgical site infections (SSI)

Distractions and errors contribute to medical errors leading to patient harm

Disruptive developments in medical technology and medical practice are impacting how surgeries are being performed today

OR design has lagged behind and OR environmental features are often latent conditions impacting patient safety in the OR

Owens et al., 2014

Wiegmann et al., 2007

Rostenberg & Barach, 2011

Weerakkody et al., 2013

There is a need for a systemic approach to OR design that examines the role of people, tasks, technology, equipment and the built environment on patient and staff safety outcomes in the OR

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

BRIDGING THE IDEAL WITH REALITY WORK AS

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IMAGINED

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BRIDGING THE IDEAL WITH REALITY WORK AS

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INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

WORKSHOP OVERVIEW Innovations in Surgical Environments will provide a comprehensive and in-depth look into a broad range of topics impacting surgery center design today and in the future.

n g i s e y D t i s s r e i The workshop will provide t e i l v i i actionable tools and c n a approaches to support project U F n teams in the design of safer, h o t l s more ergonomic ambulatory a m e surgical environments, and e H l represents the culmination ofr C o f a four-year multi-disciplinary r e research effort. t n e C

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INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

WORKSHOP OBJECTIVES TOPICS TO BE EXPLORED ON DAY1

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Innovations in surgical environments

Case study exemplars in outpatient surgical environments

Designing preoperative and postoperative workspaces

Designing outpatient waiting areas

Findings from a 4-year patient safety learning lab focused on OR design

Evidence-based design strategies for OR design

Preview of the newly released Safe OR Design Tool

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STEPS IN THE HEALTHCARE EXPERIENCE REGISTRATION AND WAITING AREA

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PRE-OPERATIVE AREA

OPERATION ROOM

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POST-OPERATIVE AREA

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

INNOVATIONS IN SURGICAL ENVIRONMENTS Designing Waiting Rooms in Surgery Centers

Designing Preoperative & Postoperative Workspaces

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Waiting rooms are the first point of contact between end-users and healthcare systems and thus, can influence their overall impression of quality of care in healthcare facilities. To date, most research on waiting rooms has focused on passive positive distractions as well as the physiological and psychological impact of these ambient features on users. Using Virtual Reality (VR), this study investigated how factors including privacy, seat location, type of seating, accessibility, and visibility of areas in an outpatient surgical waiting room can impact userâ&#x20AC;&#x2122;s location and seat preferences when they are engaged in typical certain activities

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The current model of disjointed ambulatory care is moving toward a model of collaborative coordinated care where different disciplines work together to provide care to the patient. In this model, the patient and family are also envisioned as part of the team. The ambulatory care workspace (layout, furniture, equipment) will need to be re-envisioned to support these types of interactions. There is an urgent need to focus on the evolving staff workspace in ambulatory care environments.

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Designing Operating Rooms

The overarching goal of the learning lab titled, â&#x20AC;&#x153;Realizing Improved Patient Care through Human-Centered Design in the Operating Room (RIPCHD.OR) is to develop an evidence-based framework and methodology for the design and operation of operating rooms such that it impacts improved perioperative outcomes including surgical site infections, surgical errors and staff injuries. INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

OVERVIEW OF PROJECTS REGISTRATION AND WAITING AREA

Designing Waiting Rooms in Surgical Environments

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PRE-OPERATIVE AREA

OPERATION ROOM

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POST-OPERATIVE AREA

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

OVERVIEW OF PROJECTS REGISTRATION AND WAITING AREA

PRE-OPERATIVE AREA

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OPERATION ROOM

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POST-OPERATIVE AREA

Designing preoperative & postoperative workspaces

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

OVERVIEW OF PROJECTS REGISTRATION AND WAITING AREA

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OPERATING ROOM

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POST-OPERATIVE AREA

Realizing Improved Patient Care through Human-Centered Design in the Operating Room (RIPCHD.OR)

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

WORKSHOP AGENDA DAY 1 SEPTEMBER 12, 2019 08:30 – 09:00 09:00 – 10:00 10:00 – 11:00

Welcome & introductions Keynote: Innovations in surgical environments Case study exemplars

11:00 – 11:15

Morning break

11:15 – 12:00 12:00 – 12:30

Designing preoperative & postoperative workspaces Designing waiting areas

12:30 – 01:30

Lunch

01:30 – 01:45 01:45 – 02:30 02:30 – 03:15

RIPCHD.OR project introduction RIPCHD.OR research findings Safe OR prototype & “Safe OR Design Tool” preview

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03:30 – 03:45 03:45 – 04:00 04:00 – 05:15 05:15 – 05:45 05:45 – 07:00 07:00 – 09:00

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

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Andrew Ibrahim Lynn Martin, Mark Gesinger; Cara Tubbs, Michael Folonis

Afternoon break

Design implementation Future state OR Panel discussion Recognition and closing remarks Evening Networking Reception Dinner (individual choice)

Becky Smith

William Berry, Alex Langerman, Bryan Langlands, Lynn Martin, David Ruthven

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

KEYNOTE SPEAKER

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e T REDESIGNING SURGICALd CARE TO n OPTIMIZE NETWORK DELIVERY a n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o ANDREW M. IBRAHIM f r e t n e C Andrew M. Ibrahim MD, MSc is a House Staff Surgeon at the University of Michigan and Chief Medical Officer at HOK Architects. He leads efforts to merge health and architecture expertise to improve population health through a fundamental redesign of how we understand the interface of health and design. His research evaluating population level strategies to improve health care delivery has resulted in numerous peer-reviewed publications, book chapters, international presentations and appointment to the editorial board at the Annals of Surgery.

CMO & Senior Principal, HOK Resident Surgeon,University of Michigan

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

REDESIGNING SURGICAL CARE TO OPTIMIZE NETWORK DELIVERY

g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e ANDREW M. IBRAHIM MD, MSc e H l r C o f r e t n e C

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INNOVATIONS IN SURGICAL ENVIRONMENTS Charleston, SC

CMO & Senior Principal, HOK | Resident Surgeon, University of Michigan

September 12th @andrewmibrahim

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Front Line of Patient Careâ&#x20AC;¦

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SURGERY

@andrewmibrahim

Evaluating Health Policyâ&#x20AC;¦

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RESEARCH

@andrewmibrahim

Designing for Healthâ&#x20AC;¦

g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f ARCHITECTURE r e t n e

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(views my own)

@andrewmibrahim

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HEALTH IN 2019

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g i s e IMPROVE y D t i s s QUALITY r e i t e i l v i i c n a U F DECREASE COSTS n h o t l s a m e IMPROVE e H l r C POPULATION o f @andrewmibrahim

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g i s IMPROVE e y D t i QUALITY s s r e i t e i l v i i c n a DECREASE U F n h COSTS o t l s a m e e H IMPROVE l r C POPULATION o f

@andrewmibrahim

The Bad News…

g i It’s (almost) all about moneyes y D t i s s r e i t e i l v i i c n a U F The Good News… n h o t l s a m e e H l r It’s (almost) all about money C o f r (and people respond to that.) e t n e C

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The Bad News…

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@andrewmibrahim

g n i t s e T Payment Policies that Influence Design d n a n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s BUNDLE NO PAYMENT PAY FOR HEALTH a m e e H l “NEVER EVENTS” “UPSTREAM” PAYMENTS r C o f r e t n e C @andrewmibrahim

Payment & “NEVER EVENTS”

@andrewmibrahim

Payment & “NEVER EVENTS” No Payment for Safety Never Events Examples Retained Foreign Body Falls Results in Injury Catheter- Associated Infections Surgical Site Infections @andrewmibrahim

Make Payments in BUNDLES

@andrewmibrahim

Make Payments in BUNDLES

@andrewmibrahim

Make Payments for VALUE

@andrewmibrahim

It’s Just Not Fair…

@andrewmibrahim

“It’s Just Not Fair” Risk-Adjust Socioeconomic Factors?

NO PAYMENT “NEVER EVENTS”

BUNDLE PAYMENTS

@andrewmibrahim

Pay for HEALTH “Upstream”

@andrewmibrahim

Pay for HEALTH “Upstream” $157 million CMS pilot to improve health upstream

Housing

Food

Utilities

Safety

Transport @andrewmibrahim

Pay for HEALTH “Upstream” Designed for Clinician Use

@andrewmibrahim

Shift toward Payment Beyond Hospitals

NO PAYMENT “NEVER EVENTS”

BUNDLE PAYMENTS

PAY FOR HEALTH “UPSTREAM”

@andrewmibrahim

Insurers Paying forâ&#x20AC;Ś Housing?(!)

@andrewmibrahim

Insurers Investing Inâ&#x20AC;Ś Food Access?(!)

@andrewmibrahim

We May Spend Too Much On Healthcare (15-18%) But How are We Spending the Other >80%? @andrewmibrahim

What if Everything we Build and Design was Done with Health as a Priority? London, United Kingdom. June 2019.

Ibrahim. In Press, Fall 2019. @andrewmibrahim

Trend #1: Healthcare Money (& Strategy) Moving Outside of Hospitals (Even for Surgeons)

@andrewmibrahim

Youâ&#x20AC;&#x2122;re a Doctor Now, Right?

@andrewmibrahim

Choosing a Hospitalâ&#x20AC;Ś.

@andrewmibrahim

Choosing a Hospitalâ&#x20AC;Ś.

@andrewmibrahim

If You Had to Have Surgery, Where Would You Go?

@andrewmibrahim

Rates of Serious Complications (%)

U.S. Variation in Serious Complications 14.0% 13.0% 12.0% 11.0% 10.0% 9.0%

Total Variation â&#x20AC;&#x201C; 42 fold 0.34% to 14.6%

8.0% 7.0% 6.0% 5.0% 4.0% 3.0% 2.0%

Ibrahim et al., JAMA Surg April. 2017

1.0% 0.0%

101

151

Centers of Excellence Ranked by Rates of Serious Complications @andrewmibrahim

U.S. Variation in Readmissions after Surgery

Tsai et al., N Engl J Med. 2013

@andrewmibrahim

1 in 5 PATIENTS WOULD TOLERATE 18% MORTALITY (VERSUS 3%) TO STAY LOCAL FOR CARE.

@andrewmibrahim

“When I need a big heart operation, I’ll go across town.” @andrewmibrahim

Wait, WHAT?

% Mortality after Inpatient Surgery

@andrewmibrahim

Did My Mom Go To the Right Hospital?

% Mortality after Inpatient Surgery

@andrewmibrahim

But a Closer Look …

% Mortality after Inpatient Surgery

“….procedures that have rates of death of more than 1%.”

@andrewmibrahim

Bigger is Betterâ&#x20AC;Ś? Journal of the American College of Surgeons

@andrewmibrahim

Bigger is Betterâ&#x20AC;Ś? Journal of the American College of Surgeons

k s i R h g i H , s x n e l o i p t a m r o C Ope @andrewmibrahim

WHAT ABOUT COMMON OPERATIONS? IS IT SAFE TO STAY LOCAL?

@andrewmibrahim

Data Source: Medicare Claims Cross-sectional retrospective review 2009-2013 1,631,904 Medicare Beneficiaries

Appendectomy Cholecystectomy N=155,334 N=583,991 (9.5%) (35.7%)

Colectomy N=587,878 (36.0%)

Hernia Repair N=304,701 (18.7%) Ibrahim et al. JAMA. May 2016 @andrewmibrahim

Safe to Stay Localâ&#x20AC;¦ 30

Patients (%)

25 20

25.2

17.2 13.9

15 10

6.3

5.6

5.4

Routine OPERATIONS

0 All Complications

Serious Complications

Non-Critical Access Hospitals Urban, High Volume

Mortality, 30 Days

Critical Hospitals Rural,Access Low Volume Ibrahim et al. JAMA, 2016. @andrewmibrahim

Better or Same Outcomes, but for How Much? @andrewmibrahim

â&#x20AC;Śand it costs less. Payments Amount ($)

$25000 $20000 $15000

-$5,800

-$3,027

-$1,593

$19,455 $15,637 $13,645

$12,610

$14,721 $13,128

$10000

Routine OPERATIONS

$5000 $ Actual Payments

Price Standardized

Non-Critical Access Hospitals High Volume, Urban Hospitals

Price Standardized & Adjusted Critical Access Hospitals Low Volume, Rural Hospitals

Ibrahim et al. JAMA, 2016. @andrewmibrahim

@andrewmibrahim

Two Sets of Phone Callsâ&#x20AC;¦

ADVISORY COUNCIL ON RURAL SURGERY @andrewmibrahim

Two Sets of Phone Callsâ&#x20AC;¦

ADVISORY COUNCIL ON RURAL SURGERY @andrewmibrahim

Where Is the Value?

@andrewmibrahim

How Can Value be Leveraged Across Networks? @andrewmibrahim

Youâ&#x20AC;&#x2122;re a Surgeon & a health services researcher?

@andrewmibrahim

Youâ&#x20AC;&#x2122;re a Surgeon & a health services researcher?

@andrewmibrahim

Youâ&#x20AC;&#x2122;re a Surgeon & a health services researcher?

@andrewmibrahim

Youâ&#x20AC;&#x2122;re a Surgeon & a health services researcher?

@andrewmibrahim

Youâ&#x20AC;&#x2122;re a Surgeon & a health services researcher?

@andrewmibrahim

From Designing a Single Hospital...

@andrewmibrahim

How many of you serve (or are) a client with a single site of care?

@andrewmibrahim

â&#x20AC;ŚOptimizing Network Performance. (Empirical Model & Predict?) @andrewmibrahim

Evaluating Network Performanceâ&#x20AC;Ś

Sheetz et al. JAMA Surg 2019 @andrewmibrahim

Evaluating Network Performanceâ&#x20AC;Ś

Uniform, High Quality Sheetz et al. JAMA Surg 2019 @andrewmibrahim

Evaluating Network Performanceâ&#x20AC;Ś

Highly Variable, Mixed Quality

Sheetz et al. JAMA Surg 2019 @andrewmibrahim

Evaluating Network Performanceâ&#x20AC;Ś

Can Hospital Systems Reproducibly transform to Uniform, High Quality care?

Highly Variable, Mixed Quality

Uniform, High Quality Sheetz et al. JAMA Surg 2019 @andrewmibrahim

Centralizing Model for Surgical Care

CENTRALIZED SPECIALTY CARE NON-SPECIALTY CARE PATIENT REFERRAL

Ibrahim & Dimick. N Engl J Med Catalyst. April 2017 @andrewmibrahim

High-Risk Surgery HIGHER VOLUME Improved Outcomes

Low Volume

High Volume

Birkmeyer et al. N Engl J Med, 2002. @andrewmibrahim

“VOLUME PLEDGE” FOR HIGH RISK SURGERY

@andrewmibrahim

Routine Operationsâ&#x20AC;Ś 30

Patients (%)

25 20

25.2

17.2 13.9

15 10

Safe to Stay Local 6.3

5.6

5.4

0 All Complications

Serious Complications

Non-Critical Access Hospitals Urban, High Volume

Mortality, 30 Days

Critical Hospitals Rural,Access Low Volume Ibrahim et al. JAMA, 2016. @andrewmibrahim

What About Everything Else?

@andrewmibrahim

Decentralizing Model for Specialty Care

â&#x20AC;&#x153;Uniform, High-Quality Care Anywhere In The Networkâ&#x20AC;?

@andrewmibrahim @andrewmibrahim

Strategies to Decentralize Specialty Care

Disseminate Knowledge Expertise

@andrewmibrahim

Decentralizing Model for Specialty Care SPECIFIC DIAGNOSIS

Ibrahim & Dimick. N Engl J Med Catalyst. In Press.

@andrewmibrahim @andrewmibrahim

Decentralizing Model for Specialty Care

Work-Up

Ibrahim & Dimick. N Engl J Med Catalyst. In Press.

@andrewmibrahim @andrewmibrahim

Decentralizing Model for Specialty Care TREATMENT OPTIONS

Ibrahim & Dimick. N Engl J Med Catalyst. In Press.

@andrewmibrahim @andrewmibrahim

Decentralizing Model for Specialty Care FOLLOW-UP

Ibrahim & Dimick. N Engl J Med Catalyst. In Press.

@andrewmibrahim @andrewmibrahim

Strategies to Decentralize Specialty Care

Disseminate Knowledge Expertise

Decentralize Infrastructure Investments

@andrewmibrahim

Decentralize Infrastructure Investments

@andrewmibrahim @andrewmibrahim

Decentralize Infrastructure Investments

@andrewmibrahim @andrewmibrahim

Strategies to Decentralize Specialty Care

Disseminate Knowledge Expertise

Decentralize Infrastructure Investments

Optimize Care Coordination

@andrewmibrahim

Optimize Care Coordination

@andrewmibrahim

Strategies to Decentralize Specialty Care

Disseminate Knowledge Expertise

Decentralize Infrastructure Investments

Optimize Care Coordination

Establish a Collaborative Culture

@andrewmibrahim

Establish a Collaborative Culture

PHONE-A-FRIEND @andrewmibrahim @andrewmibrahim

Optimizing Networks of Healthcare Delivery

Centralize Technical Expertise

Decentralize Knowledge Expertise

Ibrahim & Dimick. N Engl J Med Catalyst. April 2017. @andrewmibrahim

Implications for Design May not need MORE Buildings at all Redesign & repurpose existing structures Adaptability & coordination take on new importance @andrewmibrahim

Single Events to Entire Populations

NO PAYMENT “NEVER EVENTS”

BUNDLE PAYMENTS

NEW PAY FOR HEALTH “UPSTREAM” NETWORKS

@andrewmibrahim

What Year are You Designing For?

NO PAYMENT “NEVER EVENTS”

BUNDLE PAYMENTS

2000

2010

NEW PAY FOR HEALTH “UPSTREAM” NETWORKS

2030+ @andrewmibrahim

Healthcare’s New Value Proposition

NO PAYMENT “NEVER EVENTS”

BUNDLE PAYMENTS

2000

2010

NEW PAY FOR HEALTH “UPSTREAM” NETWORKS

2030+ @andrewmibrahim

Trend #2: Shift from Individual Hospital ORs to Networks Covering Regions

@andrewmibrahim

Now that the Stakes are Higher...

@andrewmibrahim

The Era of Ernest Codman (b. 1869)

@andrewmibrahim

The “End Results Idea” The common sense notion that every doctor should follow every patient it treats, long enough to determine whether or not the treatment has been successful, and then to inquire, “If not, why not?” with a view to preventing similar failures in the future. – Ernest Codman @andrewmibrahim

The “End Results Idea”

@andrewmibrahim

The “End Results Idea” Complications due to: “Lack of Judgement” “Lack of Technical Skill”

@andrewmibrahim

â&#x20AC;&#x153;So I am called eccentric for saying in public: that hospitals, if they wish to be sure of improvement, (1) must find out what their results are, (2) must analyze their results, to find out their strong and weak points; (3) must compare their results with those of other hospitalsâ&#x20AC;Śand (8) must welcome publicity not only for their successes but for their errors.â&#x20AC;?

@andrewmibrahim

Not So Popularâ&#x20AC;Ś.

@andrewmibrahim

It may take 100 years for my ideas to be accepted. @andrewmibrahim

First Cancer Registry in the United States (1924)

@andrewmibrahim

Establishing Standards… “…regular staff meetings to review cases” - Committee for Hospital Standardization

@andrewmibrahim

Morbidity & Mortality Conference

@andrewmibrahim

National Surgery Quality Improvement Program

When Surgeons Embraced Measuring Outcomesâ&#x20AC;Ś.

Established 1999 >700 Hospitals 49 of 50 States 9 Countries Outcomes for >100,000 Procedures Annually >5.4 Million Patients @andrewmibrahim

The Power of Evidence to Evaluate In the last 4 years NSQIP have been used for >10,000 research papers and citations.

@andrewmibrahim

The Power of Evidence to Predict

@andrewmibrahim

The ‘End Results Idea’ Beyond Surgery… The common sense notion that every doctor should follow every patient they treat, long enough to determine whether or not the treatment has been successful, and then to inquire, “If not, why not?” with a view to preventing similar failures in the future. @andrewmibrahim

If Codman was an Architect Talking to Clients The common sense notion that every [hospital architect] should follow every [hospital they build], long enough to determine whether or not the [hospital] has been successful, and then to inquire, “If not, why not?” with a view to preventing similar failures in the future. Modified from Codman’s “End Results Idea” (1925) where he advocated (to much controversy) that surgeons track patient outcomes after an operation.

@andrewmibrahim

Do You Consistently & Systematically Measure the Outcomes that Matter to your Clients? (awkward silence is okay)

@andrewmibrahim

Measuring Network Performance â&#x20AC;&#x153;Rather than seeing an elite provider as a hospital contained within four walls, [we] envision a web of

hospitals of varied sizes and functions within an ecosystem of primary care clinics, post-acute care facilities, behavioral health services, population health management initiatives and other programs that benefit whole communities.â&#x20AC;? INSTITUTE FOR HEALTHCARE POLICY & INNOVATION

@andrewmibrahim

Trend #3: Demand for Real Evidence (& Financial Risk?)

@andrewmibrahim

Redesigning Surgical Care for 2030â&#x20AC;Ś Surgical Care Outside the Hospital? Developing Network Strategy for ORs? Evidence Behind Your Decisions?

@andrewmibrahim

THANK YOU Thank You

@andrewmibrahim

Questions? Email: andrew.ibrahim@hok.com @andrewmibrahim www.SurgeryRedesign.com

@andrewmibrahim